脳脊髄液圧亢進に伴う脈絡膜皺襞を認めた1例

Choroidal folds in a case of elevated intracranial pressure

要約　目的：特発性脈絡膜皺襞と考えられた症例において，髄液検査で脳脊髄液圧亢進を認めた1例の報告。症例：60歳，男性。主訴は約半年前からの左眼の単眼性複視と視力低下であった。所見：左眼に遠視化と後極広範に水平方向に走る脈絡膜皺襞を認めた。低眼圧や腫瘍，後部強膜炎などの既知の脈絡膜皺襞の原因となりうる疾患はなかった。髄液検査で，初圧210mmH₂Oと高値であった。脳外科の精査で脳脊髄液圧亢進の原因は不明であった。特発性頭蓋内圧亢進に伴う脈絡膜皺襞としてイソソルビド内服を開始し，遠視と視力が一部改善した。結論：脳脊髄液圧亢進は遠視化と脈絡膜皺襞の原因となりうる。

Abstract.　Purpose：To report a case of choroidal folds apparently due to elevated intracranial pressure. Case：A 60-year-old male presented with diplopia and impaired visual acuity in the left eye since 6 months before. Findings：The left eye showed hyperopia of ＋4 diopters and horizontal choroidal folds in the posterior fundus. He had no ocular hypotension, orbital tumor of scleritis. The cerebrospinal fluid showed elevated pressure of 210 mmH₂O. He was found free of lesions causing elevated cerebrospinal pressure, leading to the diagnosis of choroidal folds secondary to idiopathic elevation of cerebrospinal pressure. Systemic treatment with isosorbide was followed by decrease in hyperopia and improved visual acuity 4 months later. Conclusion：This case illustrates that choroidal folds may develop secondary to elevated cerebrospinal pressure.